Remote Clinical Operations Support Specialist

The Opportunity

Aetna's Clinical Operations team is expanding, and we are seeking a motivated Remote Clinical Operations Support Specialist to provide essential operational support to our nursing and clinical management professionals. This is a hybrid administrative and clinical support role where your organizational skills, healthcare knowledge, and collaborative spirit will directly enable Aetna's clinical teams to deliver outstanding care management, utilization review, and disease management services to members across all lines of business.

Your Day-to-Day

• Provide administrative and operational support to Aetna's utilization management, care management, and disease management clinical teams
• Process prior authorization requests and gather supporting clinical documentation from providers and facilities
• Schedule and coordinate clinical reviews, peer-to-peer calls, and provider outreach activities
• Maintain accurate member and provider records in Aetna's clinical information systems
• Prepare reports and dashboards tracking clinical team productivity, authorization volumes, and outcomes data
• Support compliance activities by organizing documentation for URAC and NCQA accreditation reviews
• Respond to provider and internal stakeholder inquiries regarding authorization status and clinical criteria

Who You Are

• You have 2+ years of experience supporting clinical, utilization management, or case management operations
• You have knowledge of prior authorization processes, managed care terminology, and healthcare regulatory standards
• You are highly organized, reliable, and able to prioritize competing demands in a remote environment
• You have experience working with healthcare information systems and electronic health records
• You communicate professionally and effectively with clinical staff, providers, and leadership
• An associate's or bachelor's degree in healthcare administration or a related field is preferred

Benefits & Perks

• Competitive compensation with annual performance review and merit increase eligibility
• Full Aetna benefits package effective from your first day of employment
• Access to Aetna's robust learning management system and clinical education library
• Paid time off accrual starting immediately with no waiting period
• Inclusive remote work culture with strong team connectivity through virtual collaboration tools
• Structured mentorship program connecting you with clinical and operations leaders